Emerald Assisted Living Home

Based on observation and interview, the manager failed to ensure medication was stored in a separate locked room, closet, cabinet, or self-contained unit. The deficient practice posed a risk to residents who were not prescribed the accessible medication. Findings include: 1. During the environmental inspection of the facility, the Compliance Officer observed a refrigerator in the kitchen. Inside the refrigerator, the Compliance Officer observed five "Lantus" insulin pens. The pens were not stored in a locked location and were accessible to residents. 2. In an interview, E1 acknowledged medication was not stored in a locked location.

Based on record review and interview, the manager failed to ensure before or at the time of acceptance of an individual, the individual submitted documentation dated within 90 calendar days before the individual was accepted by the facility, to include whether the individual required continuous medical services, continuous or intermittent nursing services, or restraints; dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant, for one of three sampled residents. The deficient practice posed a risk if the facility was unable to meet a resident's needs. Findings include: 1. A review of R1's medical record revealed no documentation to indicate whether R1 required continuous medical services, continuous or intermittent nursing services, or restraints dated and signed by a physician, registered nurse practitioner, registered nurse, or physician assistant. 2. In an interview, E1 acknowledged R1's medical record did not include documentation to indicate whether R1 required continuous medical services, continuous or intermittent nursing services, or restraints.

Based on record review and interview, the manager failed to ensure a resident's written service plan was developed with assistance and review from the resident or resident's representative, for one of three sampled residents. The deficient practice posed a risk if the service plan was not developed to articulate the residents' decisions and agreements. Findings include: 1. A review of R1's medical record revealed a service plan dated November 1, 2023 for directed care services. The service plan was not signed by R1 or R1's representative. 2. In an interview, E1 acknowledged R1's service plan was not signed by R1 or R1's representative.

Based on observation, record review, and interview, the manager failed to ensure a resident was not subjected to restraint. The deficient practice posed a risk to the physical health and safety of a resident. Findings include: 1. Arizona Administrative Code (A.A.C.) R9-10-101(199) states "restraint" means "any physical or chemical method of restricting a patient's freedom of movement, physical activity, or access to the patient's own body." 2. During the environmental inspection of the facility, the Compliance Officer observed R4 in a geriatric chair with an attached table. R4 was in the geriatric chair and the table was in front of R4's lower torso from 10:30 AM to 3:00 PM. R4 attempted to move the table latch on multiple attempts, but was unsuccessful, and was redirected to "relax" by E2. 3. In an interview, E1 reported R4's hospice doctor recommended the geriatric chair.

Based on record review and interview, the manager failed to ensure medication administered to a resident was administered in compliance with a medication order, for one of three sampled residents. The deficient practice posed a risk if a resident experienced a change in condition due to improper administration of medication. Finding include: 1. A review of R3's medical record revealed a medication order dated August 11, 2023 for "Warfarin 4 mg (milligrams), take one tablet PO daily 5 days of the week or as instructed by Coumadin Clinic." R3's medical record also contained a medication order dated August 11, 2023 for "Warfarin 3 mg, take one tablet PO daily for 4 days in a week or instructed by Coumadin Clinic." 2. Further review of R3's medical record revealed a medication administration record (MAR) dated November 2023. R3's November 2023 MAR reflected R3 was administered one tablet of "Warfarin 4 mg" every day from November 1, 2023 to November 30, 2023. R3's November 2023 MAR also reflected R3 was administered one tablet of "Warfarin 3 mg" everyday from November 1, 2023 to November 30, 2023. R3's record did not contain any other documented instruction regarding R3's "Warfarin" medication from R3's medical practitioner. 3. In an interview, E1 acknowledged there was no other documented instruction available for review regarding R3's "Warfarin" medication. This is a repeat citation from the previous compliance inspection conducted on December 9, 2022.

Based on record review and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver immediately notified the resident's primary care provider and emergency contact. The deficient practice posed a risk if the resident did not receive adequate follow-up care. Findings include: 1. In an interview, E1 reported R3 went to the hospital in June 2023. E1 reported R3 called for emergency medical services (EMS), but E1 did not know why R3 requested EMS. 2. A review of R3's medical record revealed no documentation to indicate R3's primary care provider and emergency contact were notified of the incident in June 2023. 3. In an interview, E1 reported R3 was sent to the hospital, but no incident report was created to document R3's primary care provider and emergency contact were notified.

Based on record review and interview, the manager failed to ensure when a resident had an incident resulting in the resident needing medical services, a caregiver documented the date and time of the incident, the names of individuals who observed the incident, the individuals notified by the caregiver, and any action taken to prevent the incident from occurring in the future. The deficient practice posed a potential risk of re-injury. Findings include: 1. In an interview, E1 reported R3 went to the hospital in June 2023. E1 reported R3 called for emergency medical services (EMS), but E1 did not know why R3 requested EMS. 2. A review of R3's medical record revealed no documentation of the date and time of the incident in June 2023, the names of individuals who observed the incident, the individuals notified by the caregiver, and any action taken to prevent the incident from occurring in the future. 3. In an interview, E1 reported R3 was sent to the hospital, but no incident report was created to document the date and time of the incident, the names of individuals who observed the incident, the individuals notified by the caregiver, and any action taken to prevent the incident from occurring in the future.